This paper examines the implications of the General Agreement on Trade in Services (GATS), the World Trade Organization’s agreement governing trade in health-related services, for health policy and healthcare reform in the United States. The paper describes the nature and scope of US obligations under the GATS, the ways in which the trade agreement intersects with domestic health policy, and the institutional factors that mediate trade-offs between health and trade policy. The analysis suggests that the GATS provisions on market access, (...) national treatment and domestic regulation, which are designed to eliminate ‘regulatory barriers’ to global trade in health services, limit the range of options that state and federal regulators and legislative bodies can employ to regulate the health sector and implement healthcare reforms. As such, the paper identifies the broader social and ethical implications of free trade policy. (shrink)

Throughout their history, symbolic interactionism and critical perspective have been viewed as divergent theoretical perspectives with different philosophical underpinnings. A review of their historical and philosophical origins reveals both points of divergence and areas of convergence. Their underlying philosophies of science and views of human freedom are different as is their level of focus with symbolic interactionism having a micro perspective and critical perspective using a macro perspective. This micro/macro difference is reflected in the divergence of their major concepts, goals (...) and basic tenets. While their underlying philosophies are different, however, they are not necessarily contradictory and areas of convergence may include the concepts of reference groups and looking glass self within symbolic interactionism and ideological hegemony within critical perspective. By using a pragmatic approach and combining symbolic interactionism and critical perspectives, both micro and macro levels come into focus and strategies for change across individual and societal levels can be developed and applied. Application of both symbolic interactionism and critical perspective to nursing research and scholarship offers exciting new opportunities for theory development and research methodologies. In nursing education, these two perspectives can give students added insight into patients' and families' problems at the micro level while, at the same time, giving them a lens to see and tools to apply to problems at the macro level in health care. In nursing practice, a combined symbolic interactionism/critical perspective approach assists nurses to give high-quality care at the individual level while also working at the macro level to address the manufacturers of illness. New research questions emerge from this combination of perspectives with new possibilities for theory development, a transformation in nursing education, and the potential for new practice strategies that can address individual client and larger system problems through empowerment of clients and nurses. (shrink)

In the early 2000s, the development of local food systems in advanced industrial countries has expanded beyond creation and support of farmers’ markets and community supported agriculture farms and projects to include targeted Buy Local Food campaigns. Non-governmental groups in many U.S. places and regions have launched such campaigns with the intent of motivating and directing consumers toward more local food purchasing in general. This article examines the current manifestations and possibilities for social justice concerns in Buy Local Food campaigns, (...) by considering them within the more general category of “selective patronage“ campaigns. Historical campaign examples, such as Buy Union, Buy American, and Buy Black campaigns, offer instructive comparisons to contemporary consumer campaigns promoting local food. Through examining the construction of threats, intended beneficiaries, products to be avoided, and those to be preferentially selected, the paper demonstrates how selective patronage campaigns have emphasized social justice needs and concerns for designated groups in ways that have been potentially exclusionary of other disadvantaged groups and thus undermining of social justice more broadly. As a contemporary instance of “selective patronage,“ Buy Local Food campaigns exhibit similar contradictory impulses, which are intensified by the conceptual and practical pitfalls in designating “local.“ The article concludes by considering how the challenges and prospects for commitments to social justice in local food consumer campaigns reinforce the importance of emerging initiatives centered on domestic fair trade. (shrink)

Academic examination of the role of women as Australian citizens. Asks what it means to be a woman citizen in Australia today. Questions male domination of Australian public political life. Examines the histories of citizenship for Australian women of different ethnic and cultural backgrounds, showing how gender has been central to the construction of citizenship. Demonstrates how the masculinisation of citizenship has marginalised women's activities as citizens. Includes notes, select bibliography, notes on contributors and index. Editors both teach history at (...) the University of Western Australia and have published on women's issues and Australian history. Crawford's previous titles include 'Women and Citizenship: Suffrage Centenary'. (shrink)

Clinical next generation sequencing is a term that refers to a variety of technologies that permit rapid sequencing of large numbers of DNA segments, up to and including entire genomes. As an approach that is playing an increasingly important role in obtaining genetic information from patients, it may be viewed by public and private payers either positively, as an enabler of the promised benefits of personalized medicine, or as “the perfect storm” resulting from the confluence of high market demand, an (...) uproven technology, and an unprepared delivery system. A number of recent studies have noted that coverage and reimbursement will be critical for clinical integration of NGS, yet the evidentiary pathway for payer decision-making is unclear. Although there are multiple reasons for this uncertain reimbursement environment, the situation stems in large part from a long-standing lack of alignment between the information needs of regulators and post-regulatory decision-makers such as payers. (shrink)

The exportation of Western biomedicine throughout the world has not resulted in a systematic homogenization of scientific ideology but rather in the proliferation of many forms and practices of biomedicine. Similarly, in the last decade, bioethics has become increasingly an international enterprise. Although there may be consensus regarding the inherent value of ethical discourse as it relates to health and medical care, there are disagreements about the nature and parameters of medical morality. This lack of consensus exists because our beliefs (...) about morality are culturally constituted, embedded in social, religious, and political ideologies that influence particular individuals and communities at specific historical moments. (shrink)

This grounded study investigated the negotiation of authorship by faculty members, graduate student mentors, and their undergraduate protégés in undergraduate research experiences at a private research university in the northeastern United States. Semi-structured interviews using complementary scripts were conducted separately with 42 participants over a 3 year period to probe their knowledge and understanding of responsible authorship and publication practices and learn how faculty and students entered into authorship decision-making intended to lead to the publication of peer-reviewed technical papers. Herein (...) the theoretical model for the negotiation of authorship developed through the analysis of these interviews is reported. The model identifies critical causal and intervening conditions responsible for the coping strategies faculty and students employ, which, in our study, appear to often produce unfortunate consequences for all involved. The undergraduate student researchers and their graduate student mentors interviewed in this study exhibited a limited understanding of authorship and the requirements for authorship in their research groups. The power differential between faculty and students, the students’ limited epistemic development, the busy-ness of the faculty, and the faculty’s failure to prioritize authorship have been identified as key factors inhibiting both undergraduate and graduate students from developing a deeper understanding of responsible authorship and publication practices. Implications for graduate education and undergraduate research are discussed, and strategies for helping all students to develop a deeper understanding of authorship are identified. (shrink)

The severe shortage of organs for transplantation and the continual reluctance of the public to voluntarily donate has prompted consideration of alternative strategies for organ procurement. This paper explores the development of market approaches for procuring human organs for transplantation and considers the social and moral implications of organ donation as both a gift of life and a commodity exchange. The problematic and paradoxical articulation of individual autonomy in relation to property rights and marketing human body parts is addressed. We (...) argue that beliefs about proprietorship over human body parts and the capacity to provide consent for organ donation are culturally constructed. We contend that the political and economic framework of biomedicine, in western and non-western nations, influences access to transplantation technology and shapes the form and development of specific market approaches. Finally, we suggest that marketing approaches for organ procurement are and will be negotiated within cultural parameters constrained by several factors: beliefs about the physical body and personhood, religious traditions, economic conditions, and the availability of technological resources. (shrink)

The development of the Functional Genomics Investigation Ontology (FuGO) is a collaborative, international effort that will provide a resource for annotating functional genomics investigations, including the study design, protocols and instrumentation used, the data generated and the types of analysis performed on the data. FuGO will contain both terms that are universal to all functional genomics investigations and those that are domain specific. In this way, the ontology will serve as the “semantic glue” to provide a common understanding of data (...) from across these disparate data sources. In addition, FuGO will reference out to existing mature ontologies to avoid the need to duplicate these resources, and will do so in such a way as to enable their ease of use in annotation. This project is in the early stages of development; the paper will describe efforts to initiate the project, the scope and organization of the project, the work accomplished to date, and the challenges encountered, as well as future plans. (shrink)

Multiple gestations, or multifetal pregnancies,raise a number of significant policy questionsconcerning the well being of women and the wellbeing of the children fetuses might become.Important questions for feminists pertain notonly to multifetal pregnancy itself, but alsoto the medical interventions associated withthese pregnancies. In this paper, we addressthe questions of how many embryos should betransferred in assisted reproduction, how manyfetuses should remain in a multiple gestation,who should make these decisions, and the needto protect women from overexposure to exogenoushormones. Although we focus (...) on assistedreproduction in the United States, we believethat our suggestions are applicable to othercountries where the technology is comparable. (shrink)

The main purpose of this article consists in discussing the idea of moral responsibility in Abraham’s case as it is put forward in Fear and Trembling. With this idea in mind, the notion of ethical heteronomy that the author defends is opposed to kantian ethical autonomy. From this viewpoint, religious sacrifice not only cannot but also must not be ethically justified. The discussion is developed considering Kierkegaard’s ideas from the perspective of different contemporary ethical theories.

The relationship between intimacy and honesty seems a paradoxical one. While intimate relationships would seem to demand a high level of honesty, this same intimacy might make us more likely to shield the other or protect ourselves through benevolent lying or the withholding of information. It would seem that honesty may not always be the best policy in intimate relationships. The purpose of this article is to examine the tension between honesty and intimacy in Kant’s duty of friendship, and it (...) will highlight the limitations of Kant’s expectations of friendship. At the same time I will use Kant’s own appeal to the autonomy of moral agents to delineate an appropriate role for the obligations of honesty and self disclosure in friendship. (shrink)

Transcription initiation by σ54–RNA polymerase (RNAP) relies explicitly on a transient interaction with a complex molecular machine belonging to the AAA+ (ATPases associated with various cellular activities) superfamily. Members of the AAA+ superfamily convert chemical energy derived from NTP hydrolysis to a mechanical force used to remodel their target substrate. Recently Bordes and colleagues,1 using a protein fragmentation approach, identified a unique sequence within σ54‐dependent transcriptional activators that constitutes a σ54‐binding interface. This interface is not static, but subject to nucleotide‐dependent (...) movement which may represent a common mechanism for controlling output that has been adopted by other AAA+ proteins. BioEssays 25:1150–1153, 2003. © 2003 Wiley Periodicals, Inc. (shrink)

Jones's (1991) issue-contingent model of ethical decision making posits that six dimensions of moral intensity influence decision markers' recognition of an issue as a moral problem and subsequent behavior. He notes that "organizational settings present special challenges to moral agents" (1991, p. 390) and that organizational factors affect "moral decision making and behavior at two points: establishing moral intent and engaging in moral behavior" (1991, p. 391). This model, however, minimizes both the impact of organizational setting and organizational factors on (...) these experiences of ethical issues. In this theory, context is modeled as affecting the moral intent and behavior of the actor rather than directly affecting the issue's moral intensity. Here we look specifically at the effect of context on the moral intensity of ethical issues through a phenomenological study. Our results indicate that in certain environments, context may be critical in affecting the moral intensity of ethical issues. Thus, researchers should consider it more fully when assessing these issues' moral intensity. (shrink)

Today’s business students are tomorrow’s business leaders. To ensure they have skills in creating profitable, pro-social, ethical organizations, we need to consider alternative methods of teaching CSR. In this proposed symposium, we will present different approaches to international CSR/Service-Learning.

Most contemporary discussions of institutional ethics take contractual rather than fiduciary relations as the model for describing moralresponsibilities, leaving institutional boards with few resources to support and critique their moral behavior. I argue that institutional fiduciary relationships cannot be characterized as contracts, either in fact or function. Each form of relationship privileges a different set of behaviors and values that are far from interchangeable.

ABSTRACTThe health‐care reform promised by the Patient Protection and Affordable Care Act of March 2010 continues our dependence on a central feature of the American health‐care system: employer‐sponsored insurance . In this article I will criticize the assumptions regarding market and welfare concerns on which this dependence is based and argue that efforts to mandate ESI ignore both the dynamics of the employment relation and the nature of health‐care needs. A comparison between investing in employee education and investing in employee (...) health will reveal the pragmatic challenges to ESI and the covert appeal to employer beneficence on which ESI rests. This paper argues that relying on ESI to guarantee appropriate care for a significant segment of the population is undesirable and unsustainable from both market and moral perspectives. (shrink)

Soon after its publication, Readings in Ancient Greek Philosophy was hailed as the favourite to become "the 'standard' text for survey courses in ancient philosophy. Over twenty years later that prediction has been borne out: Readings in Ancient Greek Philosophy still stands as the leading anthology of its kind. It is now stronger than ever: This 5th Edition features a completely revised Aristotle unit, with new translations, as well as a newly revised glossary. The Plato unit offers new translations of (...) the Meno and Republic. In the latter, indirect dialogue is cast into direct dialogue for greater readability. The Presocratics unit has been re-edited and streamlined, and the pages of every unit have been completely reset. (shrink)

Philosophy of Communication Ethics is a unique and timely volume that creatively examines communication ethics, philosophy of communication, and the 'Other.'.

Moral distress is a phenomenon that has been receiving increasing attention in nursing and other health care disciplines. Moral distress is a concept that entered the nursing literature – and subsequently the health care ethics lexicon – in 1984 as a result of the work done by American philosopher and bioethicist Andrew Jameton. Over the past decade, research into moral distress has extended beyond the profession of nursing as other health care disciplines have come to question the impact of moral (...) constraint on individual practitioners, professional practice, and patient outcomes. Along with increased interest in the phenomenon of moral distress have come increasing critiques – critiques that in their essence point to a serious lack of conceptual clarity in the definition, study, and application of the concept. Foundational to gaining conceptual clarity in moral distress in order to develop strategies to prevent and ameliorate the experience is a careful revisiting of the epistemological assumptions underpinning our knowledge and use of the concept of moral distress. It is our contention that the conceptual challenges reveal flaws in the original understanding of moral distress that are based on an epistemological stance that holds a linear conception of cause and effect coupled with a simplistic perspective of ‘constraint’ and ‘agency’. We need a more nuanced approach to our study of moral distress such that our ontological and epistemological stances help us to better appreciate the complexity of moral agents acting in organizational contexts. We believe that critical realism offers such a nuanced approach. (shrink)

We offer a framework for organizing the literature regarding the debates revolving around infinite idealizations in science, and a short summary of the contributions to this special issue.

Background: Despite procedural innovations and increasing numbers of uterus transplant attempts worldwide, the perspectives of uterus transplant (UTx) trial participants are lacking. Methods: We conducted a mixed-methods study with women with absolute uterine factor infertility (AUFI). Participants included women who had previously contacted the Cleveland Clinic regarding the Uterine Transplant Trial and met the initial eligibility criteria for participation. In-depth interviews were conducted in conjunction with FertiQoL, a validated and widely used tool to measure the impact of infertility on the (...) quality of life of infertility patients. Results: All (n = 19) rated their overall health as good; some experienced grief and social isolation. AUFI is a life-framing experience that influences acceptance by family, partners, peers, and one’s self. UTx is a means to gain control of reproductive autonomy. UTx allows family-building and the ability to play an active role in prenatal health and well-being. Establishing and maintaining a supportive relationship is a key issue of AUFI and when considering UTx. Risks of UTx are perceived relative to risks to self/child/family posed by adoption/surrogacy. Participants had no overall preference regarding living or deceased donor. Conclusions: The ways in which women with AUFI conceptualize this condition in their lives and choices around UTx and participating in a study of the procedure are multifaceted and textured. These perspectives are critical to understanding its ethical, legal, and social implications. (shrink)

In June 1993, conjoined twins Amy and Angela Lakeberg became the focus of national attention. They shared a complex six‐chambered heart and one liver; only one could survive separation surgery, and even her chances were slim. The medical challenge was great and the ethical challenges were even greater.